Palliative Sedation in Children and Adolescents: the Repercussion in the Family

Background: Estimative demonstrate about 6% of the 20 million people needing palliative care at the end of their life are less than 15 years old. Despite of that, researchers reported several areas of parent dissatisfaction with care including confusing, inadequate, or uncaring communications with clinicians regarding treatment or prognosis of the child’s end of life. Objective: Here we show that about 90% of the families that have a child or an adolescent passing through a situation that needs Palliative Sedation think that this process was necessary to relieve the suffering of the patient. Results: In several reports, parents of terminally ill children describe their perceptions of uncaring and insufficient communication from health care professionals and link that communication with their own lingering regrets and emotional distress. Conclusion: There is the necessity to better capacity the supportive and care team, in order to diminish guilty and grieve feelings, and to provide courses to the care team that can develop the communication process among them and the family

ASPECTOS CLÍNICO-EPIDEMIOLÓGICOS DA FEBRE MACULOSA BRASILEIRA: UMA PERSPECTIVA CONTEMPORÂNEA

Introduction: Brazilian Spotted Fever (BSF) is an infectious disease transmitted by ticks of the genus Amblyomma, whose main etiological agent is the bacterium Rickettsia rickettsii, manifesting itself through an acute febrile condition. Objective: This narrative review aimed to address the epidemiological and clinical aspects of Brazilian Spotted Fever in Brazil. Methodology: A descriptive study with a retrospective approach carried out through a literature search based on data obtained from articles available free of charge in the Medline, PubMed, Scopus and SciELO databases, published from 2013 to 2023. In order to address the main theme more broadly, gray literature and data from the Notifiable Diseases Information System - SINAN were also used, which were statically analyzed using the Epi Info and BioEstat programs. Results and Discussion: In Brazil, the main species of tick vectors of Rickettsia rickettsii, obligate intracellular Gram-negative bacilli that cause Rocky Mountain spotted fever are Amblyomma cajennense and A. aureolatum. Retrospective analysis of SINAN data found an average of 163.7 cases and a lethality of 31.6. The epidemiological study found a higher incidence and mortality from FMB in the Southeast Region, mainly in white men aged 20 to 60 years. Variables such as gender, race, age group, site of infection and macro-region were also relevant in the study. Prominent symptoms include fever, headache and myalgia, and may present a broad clinical spectrum with severe cases. Serology is the basis of diagnosis and indirect immunofluorescence is the preferred test. The treatment of choice is doxycycline from the tetracycline group. Conclusion: Early detection and appropriate treatment are important to reduce morbidity and mortality from tick-borne pathogens.Introdução: A Febre Maculosa Brasileira (FMB) é uma doença infecciosa transmitida por carrapatos do gênero Amblyomma, tendo como principal agente etiológico a bactéria Rickettsia rickettsii, manifestando-se por um quadro febril agudo. Objetivo: A presente revisão narrativa teve por objetivo abordar os aspectos epidemiológicos e clínicos da Febre Maculosa Brasileira no Brasil. Metodologia: Estudo de caráter descritivo e abordagem retrospectiva realizado por meio de uma pesquisa de literatura a partir dos dados obtidos em artigos disponíveis free no banco de dados Medline, PubMed, Scopus e SciELO, publicados no período de 2013 a 2023. Além disso, no intuito de abordar a temática principal de forma mais ampla, também se utilizou a literatura cinzenta e dados do Sistema de Informação de Agravos de Notificação – SINAN, os quais foram analisados estaticamente por meio dos programas Epi Info e BioEstat. Resultados e Discussão: No Brasil, as principais espécies de carrapatos vetores da Rickettsia rickettsii, bacilos Gram-negativos intracelulares obrigatórios, causadora da febre maculosa são a Amblyomma cajennense e a A. aureolatum. A análise retrospectiva dos dados do SINAN constatou uma média de 163,7 casos e uma letalidade de 31,6. O estudo epidemiológico constatou uma maior incidência e mortalidade por FMB na Região Sudeste, principalmente em homens brancos com idade de 20 a 60 anos. Variáveis como sexo, raça, faixa etária, local de infecção e macrorregião também se mostraram relevantes no estudo. Os sintomas proeminentes incluem febre, cefaléia e mialgia, podendo apresentar um amplo espectro clínico com casos graves. A sorologia é a base do diagnóstico e a imunofluorescência indireta é o teste de preferência. O tratamento de escolha é a doxiciclina do grupo das tetraciclinas. Conclusão: A detecção precoce e o tratamento adequado são importantes para reduzir a morbidade e a mortalidade por patógenos transmitidos por carrapatos

Flavonoids from the Brazilian plant Croton betulaster inhibit the growth of human glioblastoma cells and induce apoptosis

This study investigated the effects of the flavonoids 5-hydroxy-7,4′-dimethoxyflavone, casticin, and penduletin, isolated from Croton betulaster Müll Arg., Euphorbiaceae, a plant utilized in popular medicine in Brazil, on the growth and viability of the human glioblastoma cell line GL-15. We observed that 5-hydroxy-7,4′-dimethoxyflavone and casticin were not toxic to GL-15 cells after 24 h of exposure. However, casticin and penduletin inhibited the metabolic activity of glioblastoma cells significantly at a concentration of 10 μM (p ≤ 0.05). Flavonoids casticin and penduletin also induced a significant and dose-dependent growth inhibition beginning at 24 h of exposure, and the most potent flavonoid was penduletin. It was also observed that penduletin and casticin induced an enlargement of the cell body and a reduction of cellular processes, accompanied by changes in the pattern of expression of the cytoskeletal protein vimentin. Signs of apoptosis, such as the externalization of membrane phosphatidyl serine residues, nuclear condensation, and fragmentation, were also detected in cells treated with 50–100 μM flavonoids. Our results indicate that flavonoids extracted from C. betulaster present antitumoral activity to glioblastoma cells, with penduletin proving to be the most potent of the tested flavonoids. Our results also suggest that these molecules may be promising supplementary drugs for glioblastoma treatment

Vírus Nipah: Uma Análise Abrangente do Perfil Epidemiológico e Clínico

Introduction: Among the diseases posing a serious threat to public health, those originating from viral agents assume significant importance. The Nipah virus (NiV), belonging to the Paramyxoviridae family, was documented in Malaysia during the period of 1998-1999. Due to its notable lethality in humans, its zoonotic nature, potential for interpersonal transmission, and the absence of a readily available vaccine, the World Health Organization (WHO) has identified it as a global health issue. Objective: The purpose of this study is to provide a comprehensive overview of the current state of understanding regarding Nipah Virus infection, offering a theoretical foundation for subsequent clinical investigations and interventions. Methodology: The methodology involved a descriptive search of articles from four electronic databases (PubMed, BVS, SCIELO, and Scopus), where selected articles were synthesized, providing a thorough literature review. Results and Discussion: Depending on the strain's specificity, Nipah Virus (NiV) infection manifests with neurological symptoms and severe respiratory disturbances. In confirmed cases of NiV epidemics, the presence of the virus in humans is often correlated with various animal species, with bats of the Pteropus species commonly considered primary reservoirs and natural vectors of NiV. Human transmission occurs through the consumption of contaminated food, contact with animals, and direct interpersonal interaction. Additionally, due to the lack of vaccines and drugs with established efficacy against NiV, the therapeutic approach for patients is limited to supportive measures and prophylactic intervention. Conclusion: The Nipah Virus (NiV) poses a potential threat for spread among human populations and livestock in a specific geographic region. Therefore, the foundations for managing this disease lie in implementing biosafety practices, including proper management of reservoirs and intermediate/amplifying hosts, and in the development of potential therapeutic measures.Introdução: Entre as enfermidades que constituem uma séria ameaça à saúde pública, destacam-se aquelas originadas por agentes virais, as quais assumem uma significativa importância. O vírus Nipah (NiV), pertencente à família Paramyxoviridae, foi documentado na Malásia durante o período de 1998-1999. Em virtude de sua notável letalidade em seres humanos, de sua característica zoonótica, da capacidade potencial de transmissão interpessoal, e da ausência de uma vacina prontamente disponível, a Organização Mundial da Saúde (OMS) identificou-o como uma questão de saúde global. Objetivo: O propósito deste estudo consiste em apresentar uma perspectiva abrangente do estado atual do entendimento acerca da infecção pelo Vírus Nipah, fornecendo uma fundamentação teórica para investigações e intervenções clínicas subsequentes. Metodologia:  A metodologia consistiu em uma pesquisa descritiva de artigos de quatro bases de dados eletrônicas (PubMed, BVS, SCIELO e Scopus), na qual os artigos selecionados foram sintetizados, oferecendo uma revisão completa da literatura. Resultados e Discussão: Dependendo da especificidade da cepa, a infecção pelo Vírus Nipah (NiV) manifesta-se por sintomas neurológicos e distúrbios respiratórios graves. Nos casos confirmados de epidemias de NiV, a presença do vírus em seres humanos frequentemente está correlacionada com diversas espécies animais, sendo os morcegos da espécie Pteropus comumente considerados os principais reservatórios e vetores naturais do NiV. O contágio humano ocorre por meio do consumo de alimentos contaminados, do contato com animais e da interação direta entre indivíduos. Além disso, devido à ausência de vacinas e de medicamentos com eficácia estabelecida contra o NiV, a abordagem terapêutica para os pacientes é restrita a medidas de suporte e intervenção profilática. Considerações finais: O Vírus Nipah (NiV) constitui uma ameaça potencial para a disseminação entre populações humanas e animais de criação em determinada região geográfica. Logo, os fundamentos para a gestão dessa enfermidade residem na implementação de práticas de biossegurança, que incluem uma administração apropriada do reservatório e dos hospedeiros intermediários/amplificadores e no desenvolvimento de potenciais medidas terapêuticas. &nbsp

Bioethics Inserted in Oncologic Palliative Care: a Systematic Review

Introduction: Bioethics emerges in oncologic palliative care from the reflctions of that care at the end of life for cancer patients are usually inadequate because the individuals has little relief of symptoms, adverse reactions to treatment, threats of physical, social and psychological destruction and loss of functions.Material and Findings: Systematic review in MEDLINE, IBECS, LILACS and SciELO from 1 st January, 2006 to 10th January. The searchvwas conducted with the descriptors "CuidadosPaliativos" (DeCS);"Oncologia" (DeCS); "Morte e Morrer" (Keyword); and "Bioética" (DeCS) during the month of December 2013. The literature points out that physicians should not accept something as absolute truth; and to help them in their choices at the moment comes to bioethics, which does not provide ready answers, but, with its pluralistic view, makes us exercise the capacity for reflction in choosing the best conduits for the patient. It is necessary to rescue more widely the value of the care that was in the background before the search for the cure of diseases, which in a broader sense, encompasses human, spiritual and social aspects. In Brazil, the practice of euthanasia or assisted suicide are illegal conduct that typify the crime of murder, however, the suspension of therapeutic effort is not prohibited (SET), extensively comment, orthothanasia.Conclusion: Despite the possible philosophical and ideological differences, it is necessary that health professionals to really take care of severe patients, prove conscious and attentive to the rights of the individual, the real meaning of the concepts of health and disease, issues the lack of therapeutic possibilities, extreme old age and death

Zika virus: - a review of the main aspects of this type of arbovirosis

Abstract The objective of this study was to integrate findings related to Zika virus from the scientific literature. An integrative review of Medline was conducted, and data search was performed using the Health Sciences Descriptor Zika virus and the following filters: full texts available; studies in humans; full articles; and publications in Portuguese, French, English, and Spanish. After application of the filters, followed by reading of the titles, abstracts, and full texts, 44 studies were included in the review, for which content analysis was performed. A large part of the literature comprised review articles (84%; N=37); the majority was in English (95%, N=42). In 2016, 84% (N=37) of our sample articles was published, while in 2017, 16% (N=7) was published. The main form of viral transmission was thorough the mosquito Aedes aegypti (N=30). In addition, sexual transmission (N=09), transmission through blood transfusion (N=16), vertical transmission (N=21) and transmission from occupational activities (N=03) occurred. It was possible to diagnose the disease by testing blood (N=22), urine (N=14), saliva (N=06), semen/sperm (N=03), cerebrospinal and amniotic fluid, and other tissues (N=02). Symptomatology occurred in 1-5 people (N=10) between 3 and 7 days after a mosquito bite (N=09). Complications observed were Guillain Barré syndrome (N=27); neurological Zika syndrome (N=27); meningitis, meningoencephalitis, and myelitis (N=07); deaths and/or newborns (N=03). The review provides scientific evidence that contributes to the care, planning and implementation of public policies